| NPI | 1265852933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA LAYNE BUSH-TYLDSLEY Licensed Professional Counselor 602-741-6173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NJ 37PC00160900) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |